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Abstract
Acute coronary syndrome (ACS) incidence has increased, nowadays and despite decreased mortality rate with improved therapeutic approaches, yet there are still other concomitant risk factors that may increase both morbidity and mortality after ACS.
Depression and anxiety has been identified as risk factor affecting morbidity and mortality in patient with ACS. Depression has been found as an independent predictor of increased mortality after AMI. Anxiety has been associated with increase in hospital complication and increase risk of fatal CAD and non fatal MI, yet it sometimes may be beneficial, if in appropriate level, as it may lead to early seeking of medical advice.
In addition depression and anxiety following ACS has been found to affect the quality of life of the patient, as it lead to decrease adherence of the patient to both the pharmacological treatment and to the health promoting behavior as diet, exercise, smoking, follow up. And hence this leads to increase risk of adverse cardiac outcomes.
There is high incidence of depression and anxiety following ACS and this was explained by the presence of evidence of path physiological links that explains between them.
Hence, screening for depression and anxiety has become crucial in ACS patient, to improve outcome and quality of life of the patient. Education should be done to primary care physicians and cardiologist about the importance of early detection of depression and anxiety and the effect of their management on the outcome and lifestyle of the patient. Also screening tools should be explained to them to be done as a routine in ACS patients.
Management of depression include pharmacological treatment and non pharmacological management including cognitive behavioral therapy, interpersonal psychotherapy, electroconvulsive therapy, exercise therapy, group support, targeted therapy of psychosocial needs, counseling or education.
Management of anxiety includes cognitive-behavioral treatment and pharmacological treatment if there is no contraindication. The choice of pharmacological treatment should be done with cautious according to the presence of other co morbidity.
In Addition cardiac rehabilitation must be added to the management plan, which aims to reverse limitations experienced by patients. Cardiac rehabilitation promotes recovery, reduces disability and prevents further illness. It helps in a number of ways; it helps people to change poor health habits and encourages them and their families to actively ‘fight back’ against the chronic illness. It also helps them to regain their confidence, which avoid unnecessary restriction socially or vocationally. It helps people to recover psychologically.
Management of ACS patients needs a rehabilitation team both in the hospital and in the community working together in an integrated manner with primary care staff. This is because rehabilitation should start before discharge.
Also education should be done to the patients recovering from a cardiac event to help them return to normal activity. There is a growing need for services that help patients improve their quality of life, increase functional capacity and decrease disability. Aspects of education include for example smoking, diet habits, Alcohol, hypertension, serum lipid, diabetes, physical activities, sexual activities, driving, flying and return to work.